Under and Over Nutrition

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Under and Over Nutrition

• Lecture 16
• March 23, 2009
• Dr. Quadro

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• MALNUTRITION results from imbalance between the
  bodys need and the intake of nutrients, which
  can lead to syndromes of deficiency, dependency,
  toxicity or obesity.

• MALNUTRITION includes under-nutrition, in which
  nutrients are undersupplied, and over-nutrition,
  in which nutrients are over supplied.

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Under-Nutrition(Deficiencies)
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• FAULTY OR INADEQUATE NUTRITION
• Biochemical (sub clinical) marginal state of
  malnutrition with no apparent clinical signs or
  symptoms
• Pathological (clinical) a deficiency state of
  malnutrition with apparent but not necessarily
  distinctive clinical signs or symptoms.

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UNDER-NUTRITION

• Can result from inadequate food intake
  malabsorption systemic loss of nutrients due to
  diarrhea, hemorrage, renal failure or excessive
  sweating infection or addition to drugs.

• Is associated with poverty and social
  deprivation.
• Over 800 million people suffer from persistent
  hunger and malnutrition (another billion is
  perilously close).
• The nutrients most likely to be lacking are iron,
  iodine and vitamin A.

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• The risk of under-nutrition is greater under
  certain circumstances or at certain stage of the
  life cycle
• Infancy and childhood
• Pregnancy and lactation
• Old age
• Chronic diseases
• Vegetarian diets
• Alcohol or drug dependency

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TYPES OF UNDER-NUTRITION

• Protein-Energy Malnutrition
• Micronutrients Malnutrition

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PROTEIN-ENERGY MALNUTRITION (PEM)

• Also called protein-calorie malnutrition (PCM)
  the worlds most widespread malnutrition problem,
  includes both kwashiorkor and marasmus, as well
  as the states in which they overlap (affect 500
  million of children).

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PROTEIN DEFICIENCY-THE WET FORM

• Kwashiorkor (kwash-ee-OR-core) a deficiency
  disease caused by inadequate protein in the
  presence of adequate food energy.

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KWASHIORKOR

• Sickness of the just-weaned child when the new
  baby arrives
• Diet based on watery cereal
• Clinical signs
• apathy, growth arrest, new hair with no color,
  intestinal absorption failure, edema (fluid leaks
  out of the blood and accumulates in belly and
  legs), anemia, fatty liver, infections (measles
  might be lethal), dysentery.

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Energy deficiency-the dry form

• Marasmus (ma-RAZ-mus) an energy deficiency
  disease starvation.

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MARASMUS

• A marasmic child looks like a little old
  person, just skin and bone
• Loss of muscle and body fat
• Clinical signs
• weak heart, subnormal body temperature, slow
  metabolism, impaired brain development, very low
  resistance to diseases

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World distribution of PEM

• Prevalent in Africa, Central America, South
  America and Asia.
• -over 50 of young children in South Asia
• -30 of children in Sub-Saharan Africa

• Cases reported in American Indian reservations
  and rural areas of the US
• Hospitalized patients

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MICRONUTRIENT MALNUTRITION

• Small amounts of essential vitamins
• (vitamin A, folic acid, etc.) and
• minerals (iodine, iron and zinc) are
• required by the human body for normal
• healthy growth and development.

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Best Known Water Soluble Vitamin Deficiencies

• Thiamin

• Niacin

Vitamin C
CHO metabolism PRO metabolism FAT metabolism
CHO metabolism
Body can make from amino acid tryptophan
Beriberi
Pellagra
Scurvy
Bleeding gums, Hemorrhages, Open wounds, loose
teeth
Muscle wasting Nerve damage
Diarrhea, Dermatitis, Dementia, Death (4Ds)
Symptoms
Fruits and vegetables
Protein milk, fish, chicken whole grains
Pork, Soy (legumes), Whole grain
Good Sources
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Deficiency of fat soluble vitamins
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Deficiency of trace minerals

• Iron
• Iodine
• Zinc

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Zinc-deficiency

• Zinc deficiency causes severe growth retardation,
  delayed sexual maturation, night blindness, hair
  loss, poor appetite, susceptibility to infection,
  delayed healing of cuts or abrasions, decreased
  taste and smell sensitivity, and poor growth in
  children.

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Functions of zinc

• It is found in every cell of the body and plays a
  major role with more than 50 enzymes that
  regulate cell multiplication and growth, normal
  metabolism of protein, carbohydrates, fat, and
  alcohol, and the disposal of damaging free
  radicals.
• Zinc is associated with the hormone insulin.
• It is involved in the utilization of vitamin A,
  taste perception, thyroid function, wound
  healing, the synthesis of sperm, and the
  development of sexual organs and bones.
• Recently, zinc has been known for its role in
  promoting a healthy immune system.

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• High protein foods, such as shellfish, meats, and
  liver.
• Two servings a day of animal protein will provide
  most of the zinc a healthy person needs.
• Whole-grain products are a good source of zinc if
  large quantities are eaten.
• Cows milk protein (casein) binds zinc and seems
  to prevent its absorption infants absorb zinc
  better from human breast milk.
• Fresh and canned vegetables vary in zinc content,
  depending on the soil in which they are grown.

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Zinc-deficiency

• Zinc is lost from the body daily in much the same
  way as protein is and it must be replenished
  daily.
• Infants, children, teenagers, and pregnant women
  have the highest zinc needs.
• The pregnant teenager is at particular risk
  because she needs zinc for her own growth as well
  as for her fetuss growth.
• Pregnant vegetarians are at risk because their
  diets are high in fiber and zinc-binding factors.
• Dieters on very-low-calorie diets have not only a
  low zinc intake.

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Zinc-toxicity

• Zinc can be toxic if consumed in large enough
  quantities.
• Symptoms vomiting, diarrhea, fever, and
  exhaustion.
• Excess of zinc supplements.

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Over-Nutrition(Obesity)
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OBESITY
. Excess of food intake that leads to high
caloric intake

• High amount of body fat in relation to lean body
  mass
• Body Mass Index (BMI) of 30 or higher

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Body Mass Index (BMI)

• Defined as weight in kilograms, divided by the
  square of the height in meters

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http//www.surgeongeneral.gov/topics/obesity/callt
oaction/fact_advice.htm
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Diagnosing Obesity

• 1. Physical Appearance - VISUAL
• Weight Accumulation can be
• Fat
• Muscle
• Water
• 2. BMI calculation
• Comparison of body weight to standard, based on
  height/weight ratio
• 3. Skinfold measurements (CALIBERS)
• Measure of subcutaneous fat (50 of body fat)
  independent of height
• 4. Determine Lean Body Mass
• Underwater weight
• Total body water

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Overweight and ObesityStatistics Overview

• 61 of adults in the US are overweight or obese
  (1999)
• Approximately 300,000 deaths each year in the US
  may be attributable to obesity

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Why is obesity an epidemic?

• how rapidly it has increased
• how many people are affected

in the US between 1980 and 2000, prevalence
of ? Overweight 6- to 11-year-olds - DOUBLED ?
Overweight adolescents - TRIPLED
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Health Implications of Obesity

• Osteoarthritis
• Obstructive sleep apnea and respiratory problems
• Some types of cancer (endometrial)
• Poor female reproductive health
• Complication of pregnancy
• Bladder control problems
• Uric acid nephrolithiasis
• Psychological disorders
• Gout

• High blood pressure, hypertension
• High blood cholesterol
• Type 2 diabetes
• Insulin resistance, glucose intolerance
• Hyperinsulinemia
• Coronary heart disease
• Angina pectoris
• Congestive heart failure
• Stroke
• Gallstones

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Whos Concerned About Obesity

• Health and Science Communities
• Government
• Consumer Advocacy Groups
• The Food and Beverage Industry
• Media
• Consumers

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Tracking Obesity

• CDC (Center for Disease Control)
• (http//www.cdc.gov/nccdphp/dnpa/obesity/trend/map
  s/)
• Behavioral Risk Factor Surveillance System
  BRFSS
• Each year, state health departments use standard
  procedures to collect data through a series of
  monthly telephone interviews with U.S. adults

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Obesity Trends Among U.S. AdultsBRFSS, 1994
(BMI 30, or 30 lbs overweight for 5 4
person)
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Obesity Trends Among U.S. AdultsBRFSS, 1995
(BMI 30, or 30 lbs overweight for 5 4
person)
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Obesity Trends Among U.S. AdultsBRFSS, 1996
(BMI 30, or 30 lbs overweight for 5 4
person)
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Obesity Trends Among U.S. AdultsBRFSS, 1997
(BMI 30, or 30 lbs overweight for 5 4
person)
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Obesity Trends Among U.S. AdultsBRFSS, 1998
(BMI 30, or 30 lbs overweight for 5 4
person)
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Obesity Trends Among U.S. AdultsBRFSS, 1999
(BMI 30, or 30 lbs overweight for 5 4
person)
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Obesity Trends Among U.S. AdultsBRFSS, 2000
(BMI 30, or 30 lbs overweight for 5 4
person)
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Obesity Trends Among U.S. AdultsBRFSS, 2001
(BMI 30, or 30 lbs overweight for 5 4
person)
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Obesity Trends Among U.S. AdultsBRFSS, 2002
(BMI 30, or 30 lbs overweight for 5 4
person)
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Obesity Trends Among U.S. AdultsBRFSS, 2003
(BMI 30, or 30 lbs overweight for 5 4
person)
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Obesity Trends Among U.S. AdultsBRFSS, 2004
(BMI 30, or 30 lbs overweight for 5 4
person)
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Obesity Trends Among U.S. AdultsBRFSS, 2005
(BMI 30, or 30 lbs overweight for 5 4
person)
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Obesity Trends Among U.S. AdultsBRFSS, 2006
(BMI 30, or 30 lbs. overweight for 5 4
person)
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Obesity Trends Among U.S. AdultsBRFSS, 2007
(BMI 30, or 30 lbs. overweight for 5 4
person)
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Globesity
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• 1 Billion

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60
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Obesity is an unbalance
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Modifiable Causes of Obesity

• Physical Activity
• Lack of regular exercise
• Sedentary Behavior
• High frequency of television viewing, computer
  usage
• Socioeconomic Status
• Low family incomes and non-working parents
• Eating Habits
• Over-consumption
• Some eating patterns that have been associated
  with this behavior are eating when not hungry,
  eating while watching TV
• Environment
• Over-exposure to advertising
• Lack of recreational facilities

http//www.obesity.org/subs/childhood/causes.shtml
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Non-changeable Causes of Obesity

• Genetics
• Greater risk of obesity has been found in
  children of obese and overweight parents

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Biological Mechanisms in Obesity
CNS Regulation Satiety Signals
Energy Absorption Fat digestion/absorption
Energy Expenditure Fat oxidation
Adipocytes
Energy Storage Long term fat storage Fat
mobilization
Energy Storage Conversion Short term fat
storage Fat oxidation
From Shi Burn, Nature Reviews Drug Discovery
(August 2004)
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Drug Discovery Targets - Actions

• Reducing energy (food) intake appetite
  suppressants
• Reduce hunger perception
• Increase fullness-SATIETY
• Reduce food intake by acting on brain mechanisms
• Blocking fat absorption
• Reduce energy (fat) intake through
  
• gastrointestinal mechanism of action
• Increasing energy expenditure
• Increase thermogenesis without required planned
  increases in activity
• Stimulating fat mobilization
• Reduce fat mass or prevention of adipocyte
  development

Meridia, Reductil
Xenical, Orlistat
Ephedrine
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Dietary Supplements-active ingredients and actions

• EGCG
• Catechin from green tea
• Increases metabolism
• CLA
• Conjugated linoleic acid from dairy products
• Decrease body fat, increase lean body mass
• Forskolin
• Roots of Coleus forskohlii plant
• Increases lean body mass

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Dietary Supplements-active ingredients and actions

• Hoodia gordonii
• Plant from the Kalahari desert
• Suppresses appetite
• Hydroxycitric acid
• Extract of Garcinia cabogia
• Suppress food intake
• Phaseolus
• Extract of white bean
• Inhibits digestive enzyme amylase carb blocker

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CLA perturbs vitamin A metabolism
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Aim for a Healthy Weight

• Determine your Body Mass Index (BMI)
• If you are overweight or obese, losing just 10
  of your body weight can improve your health
• If you need to lose weight, do so gradually-1/2
  to 2 pounds per week

http//www.surgeongeneral.gov/topics/obesity/callt
oaction/fact_advice.htm
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It is all about balance